AHA Journals, Author Interviews, Blood Pressure - Hypertension, Technology / 07.08.2019

MedicalResearch.com Interview with: Kang Lee, PhD Dr Eric Jackman Institute of Child Study University of Toronto Toronto, Canada MedicalResearch.com: What is the background for this study? Response: We use a technology called transdermal optical imaging I and my postdoc invented to record facial blood flow using a regular video camera on the smartphone. This technology capitalizes on the fact that light travels beneath the facial skin and reflect off the hemoglobin under the skin. Our technology captures the minute reflected photons to decode facial blood changes due to our pulses and other physiological activities. Using machine learning, a neural network model learns to use the facial blood flow to predict blood pressures taken with a FDA approved scientific blood pressure measurement instrument. We then use the final model to predict the blood pressures of a new group of participants whose data had never been used in the model training.
Author Interviews, Blood Pressure - Hypertension, JAMA, Stroke / 29.07.2019

MedicalResearch.com Interview with: "Blood Pressure Monitor" by Medisave UK is licensed under CC BY 2.0Kazuo Kitagawa, MD PhD Department of Neurology Tokyo Women's Medical University Tokyo, Japan MedicalResearch.com: What is the background for this study? What are the main findings Response:   Reduction in blood pressure (BP) reduces the rates of recurrent stroke, but the optimum BP target remained unclear. The results of RESPECT Study together with up-dated meta-analysis showed the benefit of intensive blood pressure lowering (<130/80 mmHg) compared with standard BP lowering (<140/90 mmHg). 
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 12.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50160" align="alignleft" width="200"]Prof-Kazem Rahimi Prof. Rahimi[/caption] Dr Kazem Rahimi Deputy Director of the George Centre for Healthcare Innovation James Martin Senior Fellow in Essential Healthcare Honorary Consultant Cardiologist at the John Radcliffe Hospital Deputy Director of the George Institute for Global Health MedicalResearch.com: What is the background for this study? Response: In the last century, we have witnessed a dramatic change in the spectrum of valvular heart disease and the prevalence of this condition has been rapidly increasing, due to population ageing, with poor patient outcomes and high healthcare costs associated with the only effective treatment available, which is valve repair or replacement. However, modifiable risk factors for valvular heart disease remain largely unknown, which limits prevention and treatment. We used a state-of-the-art, gene-based method called Mendelian randomization to determine the causality of the association between systolic blood pressure and risk of valvular heart diseases. 
Author Interviews, Blood Pressure - Hypertension, NEJM, Race/Ethnic Diversity / 20.03.2019

MedicalResearch.com Interview with: [caption id="attachment_48022" align="alignleft" width="133"]Dike B. Ojji, M.D., Ph.D, FWACP, FACPDepartment of MedicineFaculty of Clinical SciencesUniversity of Abuja Dr. Ojji[/caption] Dike B. Ojji, M.D., Ph.D, FWACP, FACP Department of Medicine Faculty of Clinical Sciences University of Abuja MedicalResearch.com: What is the background for this study? Response: We decided to do this research because there were no large RCTs before now that have compared the efficacy of contemporary combination therapies among any black populations in spite of the high burden of hypertension and its complications (such as heart failure, cerebrovascular accident and chronic kidney) in this population, and also the fact that majority require 2 or more medications to control their blood pressure.
Author Interviews, Blood Pressure - Hypertension, JAMA / 12.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47918" align="alignleft" width="189"]Alexander A. Leung, MD, MPHDepartment of Community Health SciencesDepartment of MedicineUniversity of CalgaryCalgary, Alberta, Canada Dr. Leung[/caption] Alexander A. Leung, MD, MPH Department of Community Health Sciences Department of Medicine University of Calgary Calgary, Alberta, Canada MedicalResearch.com: What is the background for this study? Response: The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure guidelines redefined hypertension according to a blood pressure cutoff of ≥130/80 mm Hg, compared to the traditional cutoff of ≥140/90 mm Hg.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Exercise - Fitness / 22.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47606" align="alignleft" width="200"]Michael J. Wheeler  Baker Heart and Diabetes Institute Melbourne, Victoria, Australia Michael J. Wheeler[/caption] Michael J. Wheeler Baker Heart and Diabetes Institute Melbourne, Victoria, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted this study because separate lines of inquiry have determined that a bout of exercise can acutely lower blood pressure, and more recently that prolonged sitting can increase blood pressure over the space of a day. We wanted to know whether the blood pressure lowering effects of an exercise bout would be diminished by a subsequent period of prolonged sitting or enhanced by a subsequent period of sitting that is regularly interrupted with short walking breaks. We found an additive blood pressure lowering effect when exercise was combined with breaks in sitting as opposed to exercise plus prolonged sitting. However, this was only true for women. Men had equal blood pressure lowering effects following exercise regardless of whether-or-not subsequent sitting was interrupted
Author Interviews, Beth Israel Deaconess, Blood Pressure - Hypertension, Salt-Sodium / 13.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47471" align="alignleft" width="160"]Stephen P. Juraschek, MD, PhD Assistant Professor, Harvard Medical School Beth Israel Deaconess Medical Center Division of General Medicine, Section for Research Boston, MA  02215 Dr. Juraschek[/caption] Stephen P. Juraschek, MD, PhD Assistant Professor, Harvard Medical School Beth Israel Deaconess Medical Center Division of General Medicine, Section for Research Boston, MA  02215 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lightheadedness with standing is an important risk factor for falls. Sodium is often considered a treatment for lightheadedness with standing. We examined this in the setting of a monitored feeding study where adults ate each of 3 different sodium levels for 4 weeks at a time. Participants took 5 day breaks between sodium levels and ate the sodium levels in random order. We tested the hypothesis that lowering sodium would worsen how much lightheadedness the study participants reported.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Emory, Obstructive Sleep Apnea, Race/Ethnic Diversity, Sleep Disorders / 26.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46693" align="alignleft" width="142"]Dayna A. Johnson PhD Department of Epidemiology Emory University Atlanta, GA Dr. Johnson[/caption] Dayna A. Johnson PhD Department of Epidemiology Emory University Atlanta, GA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are several studies that have determined that African Americans have the highest prevalence of hypertension and are the most likely to have uncontrolled hypertension compared to other racial/ethnic groups. We were interested in studying whether sleep apnea contributed to hypertension control among African Americans. We found that participants with sleep apnea were more likely to have resistant hypertension than those without sleep apnea. In particular, individuals with severe sleep apnea had the highest risk of resistant hypertension. Most of the participants with measured sleep apnea were undiagnosed (96%). 
Author Interviews, Blood Pressure - Hypertension / 13.12.2018

MedicalResearch.comInterview with:

Eric J. BELIN de Chantemèle, D.Sc.
Associate Professor
Department of Medicine, Cardiology
Augusta University

Eric JBelin de Chantemèle, D.Sc.
Associate Professor
Department of Medicine, Cardiology
Vascular Biology Center
Medical College of Georgia at Augusta University

Jessica L Faulkner, PhD
Post-doctoral Fellow
Vascular Biology Center
Medical College of Georgia at Augusta University

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: It is generally accepted in the medical community that women are more salt sensitive than men. By “salt sensitive” we mean that blood pressure increases with increases in salt in the diet.

While we have known for a long time that women are more likely to experience problems with their blood pressure that are associated with the salt that they eat, the reasons why remain largely unknown and, therefore, the best way to treat it is also unknown. With the average American eating roughly twice the salt recommended by the American Heart Association guidelines, the effects of dietary salt on blood pressure are very important. Our latest publication in the journal American Heart Association’s journal Hypertension shows that female mice are more prone to high blood pressure when on a high salt diet than males.

MedicalResearch.com: What should readers take away from your report?

Response: Our report begins to shed some light on why women may have a greater risk of developing high blood pressure due to eating too much salt. We recently found that a hormone, termed “aldosterone” is acting inappropriately in females in response to a lot of salt in the diet. In healthy individuals who are not salt sensitive, aldosterone is decreased by salt in the diet and is protective to the blood vessels. However, in female mice it is less likely that aldosterone will be decreased, and this lack of decrease of aldosterone leads to blood vessel damage and high blood pressure in our study.In contrast, our male mice in our study suppressed aldosterone when given a high salt diet, and did not develop blood vessel damage or high blood pressure.We believe this variation in aldosterone production in women may be a reason why they are clinically more likely to have a blood pressure response to high salt diets.

Author Interviews, Environmental Risks, Heart Disease, Nutrition / 05.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46422" align="alignleft" width="133"]Dr. Lowell H. Steen, Jr., M.D. Interventional Cardiologist Loyola University Medical Center Dr. Steen[/caption] Dr. Lowell H. Steen, Jr., M.D. Interventional Cardiologist Loyola University Medical Center Dr. Steen discusses how holiday treats & stress can increase the risk of heart attack. MedicalResearch.com: What are the main factors that are linked to an increase in heart related adverse events during the Christmas holiday season? Who is most at risk?  Response: The increase in holiday season heart-related hospitalizations and deaths are due to a variety of behaviors such as putting off seeking medical help until after the holidays, overeating rich foods, strenuous travel, excessive alcohol consumption and stressful family interactions. These factors can all trigger heart issues. Factors such as age, diabetes, high cholesterol and smoking all increase heart risk. Additionally, those with high blood pressure, which is a leading risk factor for heart disease and stroke, are exceptionally at risk and should celebrate the hectic holiday season with caution. 
AHA Journals, Author Interviews, Blood Pressure - Hypertension / 20.11.2018

MedicalResearch.com Interview with: [caption id="attachment_46155" align="alignleft" width="142"]Adam Bress, Pharm.D Department of Population Health Sciences School of Medicine University of Utah Dr. Bress[/caption] Adam Bress, Pharm.D Department of Population Health Sciences School of Medicine University of Utah MedicalResearch.com: What is the background for this study? What are the main findings? o   The background here is that the new 2017 ACC/AHA BP guidelines lowered the threshold for antihypertensive medication initiation and intensification from <140 mmHg in most patients to <130 mm Hg. o   We used contemporary, population-based studies of US adults to estimate the potential population health impact of achieving and maintaining the lower treatment targets recommended in the 2017 ACC/AHA BP guidelines compared to previous guidelines. o   We found that achieving and maintain the lower thresholds recommended in the 2017 ACC/AHA BP guidelines over 10 years would:
  • Prevent 3.0 million CVD events compared to currently blood pressure and treatment levels
  • Prevent 0.5 million more events compared to achieving and maintain JNC7 goals
  • Prevent 1.4 million more events compared to achieving and maintain JNC7 goals
o   We estimated the size of the population health impact of achieving and maintaining the lower blood pressure treatment targets in the 2017 ACC/AHA BP guidelines compared to previous guidelines.
  • Achieving and maintaining the lower blood pressure thresholds for antihypertensive medication initiation and titration by the 2017 guidelines, are projected to prevent ~20% and ~90% more CVD events over ten years compared to achieving and maintaining JNC7 or JNC8 goals respectively.
o   Although we estimated more adverse events with the lower treatment goal, what our analysis found is that the benefits of achieving and maintaining the 2017 high blood pressure treatment recommendations far outweighs the risks. Many adverse events from high blood pressure treatment can be managed medically – and the lower threshold for treatment could potentially help millions of Americans lower their chances of developing heart disease or dying from heart attacks, strokes and other cardiovascular events,
Author Interviews, Blood Pressure - Hypertension, Duke, Heart Disease, JAMA / 06.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45684" align="alignleft" width="100"]Yuichiro Yano MD PhD Assistant Professor in Community and Family Medicine Duke University Dr. Yano[/caption] Yuichiro Yano MD PhD Assistant Professor in Community and Family Medicine Duke University MedicalResearch.com: What is the background for this study? Response: New blood pressure guidelines, issued in 2017 in the US, lowered the blood pressure thresholds for hypertension from systolic blood pressure/diastolic ≥140/90 mm Hg to systolic/diastolic ≥130/80 mm Hg. This change increased the prevalence of hypertension two- to three-fold among young adults. The guidelines also newly defined elevated blood pressure as, 120-129 mmHg systolic blood pressure over 80 mmHg diastolic or less. However, no study investigated that high blood pressure, as defined by the new criteria, is something that younger people should be concerned about as a potential precursor to serious problems. Our study is among the first to report that people younger than age 40 who have elevated blood pressure or hypertension are at increased risk of heart failure, strokes and blood vessel blockages as they age.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 06.11.2018

MedicalResearch.com Interview with: "Blood Pressure Monitor" by Medisave UK is licensed under CC BY 2.0Seulggie Choi MD, (one of the co-first authors) Department of Biomedical Sciences Seoul National University Graduate School Seoul, South Korea MedicalResearch.com: What is the background for this study? What are the main findings? Response: In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) issued a new High Blood Pressure Management Guideline, in which the definition of hypertension was modified as blood pressure of 130/80 mmHg or higher. This new criteria for hypertension was based on a number of previous studies that demonstrated higher cardiovascular disease risk for participants in the systolic blood pressure of 130-139 mmHg and diastolic blood pressure of 80-89 mmHg range, which is now defined as stage 1 hypertension. However, there is a relative lack of evidence on whether this association of higher cardiovascular disease risk among those within the stage 1 hypertension category according to the 2017 ACC/AHA guidelines is also true among young adults aged 20-39 years. Our study consisted of about 2.4 million young men and women aged 20-39 years from the Korean National Health Insurance Service claims database. Compared to those with normal blood pressure, young adults with stage 1 hypertension had higher risk for cardiovascular disease, coronary heart disease, and total stroke for both men and women. Moreover, among those who were prescribed anti-hypertensive medications within the next 5 years since blood pressure measurement, young adults with stage 1 hypertension had their higher cardiovascular disease risk attenuated to that of normal blood pressure participants.
AstraZeneca, Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 05.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45702" align="alignleft" width="125"]Lei Qin Lei Qin[/caption] Lei Qin MS Director, Health Economics and Payer Analytics AstraZeneca MedicalResearch.com: What is the background for this study? Response: Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapies for patients with chronic kidney disease (CKD), but are commonly prescribed at suboptimal doses, which has been associated with worsening clinical outcomes. The objective of our study was to estimate the real-world associations between RAASi dose and adverse clinical outcomes in patients prescribed RAASi therapies with new-onset CKD in the UK.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease, UT Southwestern / 31.10.2018

MedicalResearch.com Interview with: Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586 Dr. Wanpen Vongpatanasin, M.D. Professor of Medicine Program Director, Hypertension Fellowship Program UT Southwestern Medical Center in Dallas MedicalResearch.com: What is the background for this study? What are the main findings? Response: The new US hypertension guideline places a greater emphasis on out-of-office blood pressure measurement, and maintains that a clinic BP of 130/80 mm Hg is equivalent to the same reading for home BP monitoring or daytime ambulatory BP monitoring. That is based, however, on data from non-US cohorts, primarily from Japanese cohorts and some European populations. None has been studied in the US population until now. To find out, we analyzed large multi-ethnic studies of primarily young and middle-aged adults in Dallas, Texas, and Durham, N.C., that compared home blood pressure to clinic measurements, using the regression correlation (i.e. regression approach). To confirm the findings, we use another approach called “outcome approach” by determining risks of stroke, MI, and death associated with a clinic systolic blood pressure reading of 130 mmHg from the 3,132 participants in the Dallas study during an 11-year follow up. Then, we determined the home blood pressure levels that carried the same heart disease risk and stroke risk as the clinic systolic 130 mm Hg reading. We found that the level of home blood pressure of 130/80 mm Hg actually best correlates with blood pressure taken at the doctor’s office of 130/80 mmHg. This is true for whites, blacks and Hispanic patients in both treated and untreated population. 
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Toxin Research, University of Michigan / 26.10.2018

MedicalResearch.com Interview with: [caption id="attachment_45491" align="alignleft" width="132"]Sung Kyun Park Sc.D. M.P.H. Associate professor of epidemiology and environmental health sciences University of Michigan School of Public Health, Ann Arbor, Michiga Dr. Park[/caption] Sung Kyun Park Sc.D. M.P.H. Associate professor of epidemiology and environmental health sciences University of Michigan School of Public Health Ann Arbor, Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is poorly understood that why some patients need more drugs to control high blood pressure than others. Resistant hypertension is that blood pressure is not controlled with 3 medications of different classes including diuretics or is required 4 or more medications of different classes for blood pressure controls. Genes, obesity, physical inactivity, high salt diet, pain medications may do something. Lead is a widespread environmental toxin that can influence high blood pressure. In this study, we examined whether long-term exposure to lead, measured as bone lead, is associated with the risk of resistant hypertension. Bone lead offers a better method over blood lead measurement to discern long-term lead exposure and accumulation. The main finding of our study is that low-level lead exposure, measured in the tibia (hard bone), is associated with higher risk of development of resistant hypertension in a cohort of patients diagnosed with hypertension. 
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Dental Research / 24.10.2018

MedicalResearch.com Interview with: "Still from "My Dental Hell(th)"" by littledropofpoison is licensed under CC BY 2.0Rita Del Pinto, MD University of L'Aquila Department of Life, Health and Environmental Sciences, L'Aquila - Italy  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a wealth of literature in support of a role for inflammation behind cardiovascular risk factors and diseases. One relatively poorly explored field is that of oral diseases, namely periodontitis, as a potential source of low-grade, chronic inflammation. Previous studies had described a beneficial effect of periodontal treatment on blood pressure; we extended current knowledge with our findings on over 3600 treated hypertensive adults with and without periodontitis, showing a significant benefit over systolic blood pressure behavior and control in the presence of a good periodontal health. 
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Kidney Disease, UCSF / 23.10.2018

MedicalResearch.com Interview with: [caption id="attachment_45356" align="alignleft" width="200"]Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu/) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center Dr. Shlipak[/caption] Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center MedicalResearch.com: What is the background for this study?
  • Our study represents major advancements in our understanding of whether kidney tissue damage accompanies the diagnosis of chronic kidney disease during hypertension therapy.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) was a landmark clinical trial that demonstrated that more intensive systolic blood pressure management (target <120 mmHg) reduced rates of major cardiovascular events and mortality compared with standard therapy (<140 mmHg). A recent announcement indicated that the lower systolic blood pressure target also slowed the rate of cognitive decline and dementia incidence.
  • The major concern with intensive blood pressure lowering in SPRINT is the 3-fold incidence of chronic kidney disease, as defined using the clinical standard of serum creatinine levels. This detrimental impact on the kidney was surprising because hypertension is a predominant risk factor for kidney disease, and hypertension therapy should reduce CKD risk.
  • Given the lower blood pressure targets in the recently-updated national hypertension guidelines, there has been substantial concern that guideline implementation of blood pressure targets could cause an epidemic of CKD and the attendant suffering from its downstream consequences of cardiovascular disease, heart failure, and kidney failure.
  • In our study, we compared SPRINT participants who developed CKD with matched controls, using a panel of validated urinary biomarkers of kidney damage. These urine tests can measure actual kidney damage, rather than relying on the creatinine which is an indirect reflection of the kidney’s filtering function.
  • In the group undergoing intensive blood pressure lowering in SPRINT, we found that the new cases of CKD had an overall lowering of the kidney damage biomarkers compared with the controls, contrary to what would have been expected if they were developing “real” CKD.
  • In contrast, the new CKD cases that developed in the standard treatment group did have overall elevations in the urinary biomarkers of kidney damage; 5 of the 9 biomarkers significantly increased relative to the CKD cases in the intensive treatment group. 
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, NIH, Nutrition, Race/Ethnic Diversity, Salt-Sodium / 03.10.2018

MedicalResearch.com Interview with: [caption id="attachment_44967" align="alignleft" width="133"]Dr. George Howard DPH, for the research team Professor and Chair of Biostatistics University of Alabama at Birmingham Dr. Howard[/caption] Dr. George Howard DPH, for the research team Professor and Chair of Biostatistics University of Alabama at Birmingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: Perhaps the most important distinction to draw for the readers is that this is not a paper about risk factors for hypertension, but rather a paper that looks for contributors to the black-white difference in the presence of hypertension.  This racial difference in hypertension is the single biggest contributor to the immense disparities in cardiovascular diseases (stroke, MI, etc.) that underpin the approximate 4-year difference in black-white life expectancy.  As such, this work is “going back upstream” to understand the causes that lead to blacks having a higher prevalence of hypertension than whites with hopes that changing this difference will lead to reductions in the black-white disparities in cardiovascular diseases and life expectancy.   This difference in the prevalence of hypertension is immense … in our national study of people over age 45, about 50% of whites have hypertension compared to about 70% of blacks … that is HUGE.   We think that changing this difference is (at least one of) the “holy grail” of disparities research. This study demonstrates that there are several “targets” where changes could be made to reduce the black-white difference in hypertension, and thereby the black-white difference in cardiovascular diseases and life expectancy; however, the most “potent” of these appears to be diet changes.   Even though we know what foods promote a heart healthy lifestyle, we still have major differences in terms of how that message is being adopted by various groups of Americans.  We can’t know from our data what about the Southern diet is driving these racial differences in hypertension but we can begin to design community based interventions that could possibly help to reduce these racial disparities through diet.  It is interested that diet more than being overweight was the biggest contributor to the racial disparities in hypertension.  This would suggest we might want to consider interventions to increase health foods in the diet while minimizing fried foods and processed meats. While this is not a clinical trial that “proves” that changes in diet will reduce the disparity in blood pressure, we consider the “message” of the paper to be good news, as the things that we found that contribute to this black-white difference are things that can be changed.   While it is always hard for individual people to change their diet, it can be done.   More importantly, over time we as a society have been changing what we eat … but we need to “double down” and try to change this faster.   Also, policy changes of play a role to gently make changes in these diet, where for example Great Britain has been making policy changes to slowly remove salt from the diet.   These changes are possible … and as such, we may see a day when the black-white differences in hypertension (and thereby CVD and death) may be reduced. 
Author Interviews, Blood Pressure - Hypertension, Diabetes, Pediatrics, Weight Research / 25.08.2018

MedicalResearch.com Interview with: “Chinese baby laying on a bed” by simpleinsomnia is licensed under CC BY 2.0Wanghong Xu, MD, PhD Professor of Epidemiology School of Public Health Fudan University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Developmental Origins of Health and Disease (DOHaD) hypothesis proposes that cardiovascular diseases and other chronic conditions in adulthood may be a consequence of an unfavorable intrauterine life, a relationship that is further modified by patterns of postnatal growth, environment, and lifestyle. Based on the two large-scale cohort studies, the Shanghai Women’s Health Study and the Shanghai Men’s Health Study, we observed nonlinear associations for birth weight with baseline body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), and low birth weight was linked with lower BMI, smaller WC, but larger WHR and WHtR. An excess risk of T2DM and hypertension was observed for low birth weight (<2500 g) versus birth weight of 2500-3499 g since baseline and since birth. The results support the DoHad hypothesis, and indicate the importance of nutrition in early life on health in Chinese population. 
Author Interviews, Blood Pressure - Hypertension, JAMA, Pharmacology / 17.08.2018

MedicalResearch.com Interview with: [caption id="attachment_43869" align="alignleft" width="150"]Dr Ruth Webster PhD, BMedSc(hons), MBBS(hons), MIPH(hons) Head, Research Programs, Office of the Chief Scientist Senior Lecturer, Faculty of Medicine UNSW Sydney Dr. Webster[/caption] Dr Ruth Webster PhD, BMedSc(hons), MBBS(hons), MIPH(hons) Head, Research Programs, Office of the Chief Scientist Senior Lecturer, Faculty of Medicine UNSW Sydney The George Institute for Global Health Australia MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We know from previous research that 80% of the blood pressure lowering efficacy of any medication occurs in the first half of the dose whilst most side effects occur at higher doses. We also know that most people will require at least 2 blood pressure lowering medications to reach their target blood pressure and that combining multiple pills into one combination medication helps patients take their medication more reliably. There was therefore good evidence to believe that using three half strength doses in one pill would be better than usual care in helping patients to achieve their blood pressure targets. We showed that, compared with patients receiving usual care, a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure of 140/90 or less (with lower targets of 130/80 for patients with diabetes or chronic kidney disease). It's estimated more than a billion people globally suffer from high blood pressure with the vast majority having poorly controlled blood pressure. Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke.
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease, OBGYNE / 03.07.2018

MedicalResearch.com Interview with: [caption id="attachment_42854" align="alignleft" width="128"]Jennifer J. Stuart, ScD Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology  Department of Epidemiology Harvard T.H. Chan School of Public Health  Division of Women's Health Brigham and Women's Hospital and Harvard Medical School Dr. Stuart[/caption] Jennifer J. Stuart, ScD Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology Department of Epidemiology Harvard T.H. Chan School of Public Health Division of Women's Health Brigham and Women's Hospital and Harvard Medical School  MedicalResearch.com: What is the background for this study? Response: Preeclampsia and gestational hypertension are common pregnancy complications involving high blood pressure that develops for the first time during pregnancy and returns to normal after delivery. Approximately 10 to 15% of all women who have given birth have a history of either preeclampsia or gestational hypertension. Previous studies have shown that women with a history of high blood pressure in pregnancy are more likely to develop cardiovascular disease events like heart attack and stroke later in life when compared to women with normal blood pressure in pregnancy. However, what is less clear is to what extent these women are more likely to develop chronic hypertension, diabetes, and high cholesterol and when these risk factors begin to emerge after pregnancy. We examined this question in a cohort of nearly 60,000 American women who we were able to follow for up to 50 years after their first pregnancy. Previous studies have been limited by small numbers, short follow-up, or a lack of information on shared risk factors, such as pre-pregnancy body mass index, smoking, and family history. This research was conducted within the Nurses’ Health Study II, which collected data on these pre-pregnancy factors in tens of thousands of women over several decades.
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension / 15.06.2018

MedicalResearch.com Interview with: [caption id="attachment_38151" align="alignleft" width="166"]Blood pressure monitor reading 120/80 copyright American Heart Association Blood pressure monitor reading 120/80
copyright American Heart Association[/caption] Professor Archana Singh-Manoux, PhD, HDR Epidemiology Research Director (DR1), INSERM Honorary Professor, University College London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although there have been previous studies that have linked raised blood pressure in midlife to an increased risk of dementia in later life, the term ‘midlife’ has been poorly defined and ranged from 35 to 68 years. New findings from the long-running Whitehall II study of over 10,000 civil servants has found 50-year-olds who had blood pressure that was higher than normal but still below the threshold commonly used when deciding to treat the condition, were at increased risk of developing dementia in later life. 
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Stroke / 10.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42288" align="alignleft" width="128"]Dr. Alain Lekoubou Looti, MD Msc Clinical Neurophysiology Department of Neurosciences College of Medicine Medical University of South Carolina Dr. Lekoubou[/caption] Dr. Alain Lekoubou Looti, MD Msc Clinical Neurophysiology Department of Neurosciences College of Medicine Medical University of South Carolina MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hypertension is strongly associated with stroke. Individuals who suffer a stroke are more likely to have another stroke. They also die at a rate twice as high as those who experience a first event. We have evidence that treating hypertension reduces the risk of recurrence stroke among stroke survivors. Prior hypertension guidelines defined hypertension for a systolic blood pressure (top number) equal or greater than 140 and a diastolic blood pressure (lower number) equal or greater than 90. The American college of cardiology/American heart association have published a new guideline to help healthcare providers identify and treat blood pressure including among stroke survivors. The threshold to define blood pressure has been lowered to 130 for the top number and 80 for the lower number for everyone. Unlike the general population, pharmacological treatment for stroke survivors is now recommended for systolic blood pressure greater than or equal than 130 and diastolic blood pressure greater than or equal to 80. In the same line achieving a blood pressure of less than 130/80 mmHg in stroke survivors is now recommended. In the stroke community, there has been mounting evidence to suggest that achieving lower blood pressure goal was desirable. When the new guidelines were published, we could not wait any longer to see the impact of the new guidelines on the proportion of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target. We were also curious to see how the new guidelines would potentially affect mortality among stroke survivors.  We have found that the new guidelines would result in a nearly 67% (from 29.9% to 49.8%) to relative increase in the proportion of U.S. stroke survivors diagnosed with hypertension and 54% (from 36.3% to 56%) relative increase in those not within the recommended BP target.  We have also found that if the new guidelines were applied, this would result in a 33% relative drop in mortality. 
Author Interviews, Autism, Blood Pressure - Hypertension, JAMA, OBGYNE, Pediatrics / 08.06.2018

MedicalResearch.com Interview with: “Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Ali Khashan, PhD Senior Lecturer in Epidemiology School of Public Health & INFANT Centre University College Cork Cork, Ireland MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is some evidence to suggest an increased likelihood of neurodevelopmental disorders in relation to hypertensive disorders in pregnancy, however consensus is lacking. Considering hypertensive disorders in pregnancy are among the most common prenatal complication, we decided to synthesise the published literature on this topic by conducting a comprehensive systematic review and meta-analysis. Our main findings suggest that hypertensive disorders in pregnancy are associated with about 30% increase in the likelihood of autism spectrum disorders (ASD) and ADHD in the offspring, compared to offspring not exposed to hypertensive disorders in pregnancy.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 02.06.2018

MedicalResearch.com Interview with: [caption id="attachment_41912" align="alignleft" width="125"]Dr-Jiang He Dr. Jiang He[/caption] Jiang He, MD, PhD Joseph S. Copes Chair of Epidemiology, Professor School of Public Health and Tropical Medicine Tulane University MedicalResearch.com: What is the background for this study? What are the main findings?   Response: The 2017 American College of Cardiology and American Heart Association hypertension guideline recommended lower blood pressure cut points for initiating antihypertensive medication and treatment goals than the previous hypertension guideline. We estimated the prevalence of hypertension and the proportion of the US adult population recommended for antihypertensive treatment according to the 2017 hypertension guideline. More importantly, we estimated the risk reductions of cardiovascular disease and all-cause mortality, as well as increases in adverse events, assuming the entire US adult population achieved the 2017 guideline-recommended systolic blood pressure treatment goals of less than 130 mmHg. Our study indicated the prevalence of hypertension was 45.4%, representing 105 million US adults with hypertension, according to the 2017 hypertension guideline. In addition, the proportion of individuals recommended for antihypertensive treatment was 35.9% or 83 million US adults. Based on data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and US population-based cohort studies, we estimated 610 thousand cardiovascular disease events and 334 thousand total deaths could be prevented annually in the US population if the 2017 hypertension guideline systolic blood pressure treatment goals were achieved in the entire US population. Compared to full implementation of the previous hypertension guideline, we estimated the 2017 hypertension guideline recommendations would reduce an additional 340 thousand cardiovascular disease events and 156 thousand deaths per year in the US. Implementing the 2017 hypertension guideline was estimated to increase 62 thousand hypotension, 32 thousand syncope, 31 thousand electrolyte abnormality, and 79 thousand acute kidney injury or kidney failure events. These analyses indicated implementing the 2017 hypertension guideline would significantly increase the proportion of US adults recommended for antihypertensive treatment and further reduce cardiovascular disease events and all-cause mortality, but might increase the number of adverse events in the US population.
Author Interviews, Blood Pressure - Hypertension, NEJM / 20.04.2018

MedicalResearch.com Interview with: “Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0José R. Banegas, M.D. Department of Preventive Medicine and Public Health Universidad Autónoma de Madrid Madrid, Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: Population-based studies and a few relatively small clinical investigations have defined the prognostic role of ambulatory blood pressure monitoring (ABPM) in hypertensive patients. However, previous studies were mostly limited by relatively small number of outcomes. Our study is the largest worldwide and provides unequivocal evidence that ABPM is superior to clinic pressure at predicting total and cardiovascular mortality across a wide range of clinical scenarios – the differences are striking. Also, whether white-coat hypertension is a benign phenotype is still debated. Our study demonstrates that white-coat hypertension was not benign. Lastly, masked hypertension patients (clinic BP normal but ABPM elevated) experienced the greatest risk of death.  
AACR, Author Interviews, Baylor College of Medicine Houston, Blood Pressure - Hypertension, Pancreatic / 17.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41101" align="alignleft" width="200"]Zhensheng Wang, M.P.H., Ph.D. Postdoctoral Associate Duncan Cancer Center-Bondy Baylor College of Medicine Houston, TX, US Dr. Wang[/caption] Zhensheng Wang, M.P.H., Ph.D. Postdoctoral Associate Duncan Cancer Center-Bondy Baylor College of Medicine Houston, TX MedicalResearch.com: What is the background for this study? Response: Our prior research consistently found a significant inverse association between circulating levels of soluble receptor for advanced glycation end products (sRAGE), an anti-inflammatory factor, and risk of pancreatic cancer. It has also been found that sRAGE levels or RAGE signaling are modulated by anti-hypertensive (anti-HT) medications, including angiotensin-converting-enzyme inhibitors (ACEi), β-blockers, and calcium channel blockers (CCBs). These medications have been shown in prior pre-clinical or experimental research to either increase sRAGE concentrations, decrease formation of advanced glycation end-products (AGEs), or dampen pro-inflammatory receptor for AGE (RAGE) signaling pathway. We therefore hypothesized that there would be an inverse association between use of anti-HT medications and risk of developing pancreatic cancer. Pancreatic cancer is a major public health concern in the United States, as it is the 4th leading cause of cancer-related mortality with an estimated of 43,090 deaths in 2017. Pancreatic cancer typically occurs in elderly individuals who also have chronic comorbid medical conditions, such as hypertension. Anti-HT medication use in individuals ≥ 18 years old has increased from 63.5% in 2001-2002 to 77.3% in 2009-2010, according to the National Health and Nutrition Examination Survey in the U.S. Therefore, it is of great public health significance to address the potential association between anti-HT medication use and risk of pancreatic cancer in the general population.
Author Interviews, Blood Pressure - Hypertension, JAMA, Primary Care / 16.04.2018

MedicalResearch.com Interview with: “Doctors” by Tele Jane is licensed under CC BY 2.0Doug Einstadter, MD, MPH Center for Health Care Research and Policy MetroHealth System and Case Western Reserve University  MedicalResearch.com: What is the background for this study?   Response: Despite the recognized importance of blood pressure (BP) control for those with hypertension, based on national surveys only 54% of patients with hypertension seen in primary care have their BP controlled to less than 140/90 mm Hg. Blood pressure measurement error is a major cause of poor BP control. Reducing measurement error has the potential to avoid overtreatment, including side effects from medications which would be intensified or started due to a falsely elevated blood pressure. One way to reduce measurement error is to repeat the BP measurement during an office visit. The American Heart Association recommends repeating a blood pressure at the same clinic visit with at least 1 minute separating BP readings, but due to time constraints or lack of evidence for the value of repeat measurement, busy primary care practices often measure BP only once. Repeating the BP at the same office visit when the initial blood pressure measurement is high has the potential to improve clinical decision-making regarding BP treatment. Several studies have described the effect of a repeat BP measurement in the inpatient setting, but there are little data available to characterize the effect of repeating blood pressure measurement in an outpatient primary care setting.